Assisted suicide

Over my dead body

Helping the terminally ill to die, once taboo, is gaining acceptance

VOTERS in Massachusetts will decide next month whether a terminally ill patient with less than six months to live should be able to use a doctor’s help in committing suicide. If they assent, as the polls suggest, the state will be the third, after Oregon and Washington, to legalise assisted suicide. New Jersey introduced a bill last month to decriminalise it. The Montana Supreme Court has ruled that doctors cannot be prosecuted for prescribing lethal drugs for terminally ill patients.

When Jack Kevorkian, an American doctor jailed after admitting helping 130 patients to die, first went on trial in 1994, assisting suicide was a crime everywhere save Switzerland. Now the trend is spreading far and wide (though not in Asia or in Muslim countries where it is still taboo).

In Europe the Netherlands, Belgium and Luxembourg all allow assisted suicide. Private members’ bills to legalise it are due in both the Scottish and London Parliaments early next year. In New Zealand a private member’s bill to allow the practice awaits its first reading. In Canada Quebec’s newly elected ruling party plans to bring in similar legislation. In Australia New South Wales’s Parliament is also debating the issue. Even in Catholic Ireland a High Court decision is expected imminently on whether the partner of a multiple sclerosis sufferer can help her die without himself being prosecuted.

All this reflects a big shift towards secular thinking and individual autonomy as well as growing worries about the medicalised, miserable and costly way of death that awaits many people in rich countries. Assisted suicide typically gains overwhelming public support; legislators, pro-family lobbies, churches and doctors’ groups tend to be more squeamish. They fear that legal, easy-to-get assisted suicide will have dire social and moral effects.

If you can’t fly with your own wings

Yet for the limited measures introduced so far, safeguards abound and evidence of abuse is scant. Oregon’s legislation, introduced in 1998, is widely admired. Under it, an eligible applicant must be a mentally competent adult, suffering from a terminal illness and with less than six months left to live. His decision must be “informed”, meaning he must have been told about alternatives such as hospice care and pain control, and he must have asked his doctor at least three times to be allowed to die. A second doctor must review the case both for the accuracy of the prognosis and to certify that no pressure (from inheritance-hungry relatives, say) has been exerted.

Almost all existing or proposed assisted-suicide laws contain similar safeguards. Some also require the applicant to be suffering “unbearable” physical or mental pain. Only in Belgium, the Netherlands and Switzerland, where assisted suicide has been permitted since 1942, are the non-terminally ill eligible. Yet even that liberality has not stoked the numbers. The annual total of assisted deaths among Swiss residents is still around 300, or 0.5% of all deaths. Dignitas, the only organisation in the world willing to help foreigners die, had 160 clients in 2011. In Oregon assisted suicides represent 0.2% of all deaths. In Belgium, where voluntary euthanasia is also legal, assisted dying accounts for less than 1% of the total. Even in the Netherlands, which takes a notably relaxed approach to both forms, it represents less than 3%.

Courts are an impetus for reform. Several heart-rending “right-to-die” cases have come before the House of Lords, formerly Britain’s highest court, and other courts over the past decade. That led the chief prosecutor to publish guidance on the criteria used for taking assisted-suicide cases to court. Anyone acting solely out of compassion and who had given only “minor” help (like accompanying someone to Dignitas) could expect to escape prosecution. In 2008 a 23-year-old Briton paralysed by a rugby accident went to Switzerland to end his life at Dignitas. His parents, who took him there, risked arrest on their return. But England’s public prosecutor ruled that criminal proceedings would not be in the public interest.

But the law itself has not changed: a British doctor who knowingly prescribes or administers a lethal dose of drugs could still face jail. In August Tony Nicklinson lost his lengthy “right-to-die” battle in the High Court. Stuck in what he described as a “living nightmare” after a stroke in 2005 left him unable to move or communicate save by blinking, he begged the court to allow a doctor to put an end to his life. It ruled that voluntary euthanasia remained murder, “however understandable the motives”. It was for Parliament, not the courts, to change the law, the ruling said. But British MPs appear in no hurry to do so; six in ten oppose any reform.

Many doctors throughout Europe nevertheless continue to provide a kind of passive euthanasia for patients in their final hours or days. The “Liverpool care pathway for the dying patient”, first adopted in the north-western English city in the late 1990s, is now standard practice in most British hospitals and hospices. Under it, doctors allow the patient (or his family if he is comatose) to choose whether to prolong life artificially or to remove the life-support system and let the patient die—often with the aid of an extra-strong dose of (life-shortening) painkillers. In America, beset by worries about lawsuits, such an approach is rare and risky.

The prospect of the loss of autonomy, of dignity and of the ability to enjoy life are the main reasons cited by those wanting assisted suicide. Having the option of assisted suicide means that terminally ill people can wait before choosing to end their lives. That may have been what happened to Gloria Taylor, a Canadian assisted-suicide campaigner with Lou Gehrig’s disease (a degenerative illness). After winning a landmark court case four months ago that gave her a “personal exemption” to seek a doctor’s help to commit suicide at the time of her choosing, she died earlier this month—from natural causes.